Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram.

It was a single cardiology practice quality improvement project, so results may not apply to other practices or locations. No control group or randomisation is reported, and the project had only 43 patients, so improvements cannot be attributed to the device, telehealth, or nurse-practitioner review alone. Statistical testing could not be conducted because of the small number of participants. Emergency department and urgent care reductions were based on patient self-report and recall at the end of the project. Only 30 preintervention and 21 postintervention Hospital Anxiety and Depression Scale surveys were returned, and statistical comparison of anxiety change was not conducted. Four participants already used their own KardiaMobile device before enrollment, so prior experience may have influenced anxiety or satisfaction ratings. The project lasted eight weeks, so it does not show what happens with longer use. The device has important technical limitations: unclassified rhythms need clinician review, some possible atrial fibrillation readings were actually premature atrial contractions, atrial flutter with regular intervals could be read as normal, pacemakers can create unreadable noise, movement disorders can prevent a quality recording, and it does not provide continuous around-the-clock monitoring.

Do not conclude that the smartphone device, telehealth, and nurse-practitioner review program reduces emergency department visits or anxiety. The project had no control group, emergency department reduction was patient self-report, and Hospital Anxiety and Depression Scale results were not statistically compared because too few patients had both pre and post surveys.